Research article
The association of education with body mass index and waist circumference in the EPIC-PANACEA study
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* Corresponding author: Sabine Rohrmann sabine.rohrmann@ifspm.uzh.ch
1 Division of Cancer Epidemiology, German Cancer Research Centre, Heidelberg, Germany
2 Institute of Epidemiology, Helmholtz Centre Munich, Neuherberg, Germany
3 Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
4 National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
5 Academic Medical Centre (AMC), University of Amsterdam, Amsterdam, The Netherlands
6 Medical Research Council, Epidemiology Unit, Institute of Metabolic Science, Cambridge, UK
7 Department of Epidemiology & Public Health, Imperial College London, London, UK
8 Unit of Nutrition, Environment and Cancer, Catalan Institute of Oncology, IDIBELL, Barcelona, Spain
9 Epidemiology Service, Murcia Health Council, Murcia, Spain
10 Preventive Medicine and Public Health Unit, Murcia Medical School, Murcia, Spain
11 CIBER Epidemiología y Salud Pública (CIBERESP), Spain
12 Andalusian School of Public Health, Granada, Spain
13 Public Health Department of Gipuzkoa, San Sebastian, Spain
14 Public Health Institute of Navarra, Pamplona, Spain
15 Public Health and Participation Directorate, Health and Health Care Services Council, Asturias, Spain
16 Cancer Epidemiology Unit, University of Oxford, Oxford, UK
17 Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
18 Department of Cardiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark
19 Department of Clinical Epidemiology, Aarhus University Hospital, Aalborg, Denmark
20 Danish Cancer Society, Institute of Cancer Epidemiology, Copenhagen, Denmark
21 Nutritional Epidemiology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
22 Department of Clinical and Experimental Medicine - Federico II University, Naples, Italy
23 Cancer Registry and Histopathology Unit, Department of Oncology, "Civile - M.P.Arezzo" Hospital, Ragusa, Italy
24 Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
25 ISI Foundation, Torino, Italy
26 Environmental Epidemiology, Imperial College London, London, UK
27 Department of Hygiene and Epidemiology, University of Athens Medical School, Athens, Greece
28 Hellenic Health Foundation, Greece
29 German Institute of Human Nutrition Potsdam-Rehbrücke, Nuthetal, Germany
30 Department of Medical Biosciences, Pathology, Umeå University, Umeå, Sweden
31 Department of Odontology, Umeå University, Umeå, Sweden
32 Department of Oncology, Lund University Hospital, Lund, Sweden
33 Department of Surgery, Malmö University Hospital, Malmö, Sweden
34 Institute of Community Medicine, University of Tromsø, Tromsø, Norway
35 Inserm ERI20 and Paris South University, Institut Gustave-Roussy, Villejuif, France
36 International Agency for Research on Cancer, Lyon, France
37 Insitute of Social and Preventive Medicine, University of Zurich, Zurich, Switzerland
BMC Public Health 2011, 11:169 doi:10.1186/1471-2458-11-169
Published: 17 March 2011Abstract
Background
To examine the association of education with body mass index (BMI) and waist circumference (WC) in the European Prospective Investigation into Cancer and Nutrition (EPIC).
Method
This study included 141,230 male and 336,637 female EPIC-participants, who were recruited between 1992 and 2000. Education, which was assessed by questionnaire, was classified into four categories; BMI and WC, measured by trained personnel in most participating centers, were modeled as continuous dependent variables. Associations were estimated using multilevel mixed effects linear regression models.
Results
Compared with the lowest education level, BMI and WC were significantly lower for all three higher education categories, which was consistent for all countries. Women with university degree had a 2.1 kg/m2 lower BMI compared with women with lowest education level. For men, a statistically significant, but less pronounced difference was observed (1.3 kg/m2). The association between WC and education level was also of greater magnitude for women: compared with the lowest education level, average WC of women was lower by 5.2 cm for women in the highest category. For men the difference was 2.9 cm.
Conclusion
In this European cohort, there is an inverse association between higher BMI as well as higher WC and lower education level. Public Health Programs that aim to reduce overweight and obesity should primarily focus on the lower educated population.